Kyaw Hnin Yee, Matthews Catherine, Krause Hannah G, Mwesigwa Marvin, Goh Judith T W
Gold Coast University Hospital, 1 Hospital Blvd, Southport, QLD, 4215, Australia.
Queensland Pelvic Floor Service, Greenslopes Private Hospital Ramsay Specialist Centre, Newdegate St, Suite 209, Level 2, Greenslopes, QLD, 4120, Australia.
Int Urogynecol J. 2025 May 8. doi: 10.1007/s00192-025-06137-7.
Pelvic floor disorders affect up to 50% of women in limited-resource settings (LRS) but are severely under-treated. Historically, attention has focused on urogenital fistulae, but pelvic organ prolapse (POP) is emerging as a growing issue, especially for women engaged in manual labor. Women in these regions often endure their conditions in silence owing to social stigma and mental health impacts, compounded by health care access barriers. Delivery of urogynecological services in LRS requires adaptable surgical models and skills because of limited tools and equipment. Diagnostic treatment approaches must be tailored to the unique challenges of these settings.
This article presents a practical guide to managing vesicovaginal fistulae, chronic fourth-degree tears, and POP based on limited evidence and expert experience in LRS. Key diagnostic tools, surgical techniques, and case management strategies are outlined, addressing challenges such as resource scarcity and patient follow-up in LRS.
The article emphasizes the importance of precise diagnosis with limited access to diagnostic testing, adaptable surgical interventions, and postoperative care, offering sustainable solutions that maximize patient outcomes despite restrictions in equipment availability. Cases are presented to illustrate practical diagnostic and surgical approaches to urinary leakage, fecal incontinence, and POP.
The article underscores the need for an adaptable care model that prioritizes cost-effective, reproducible methods while considering patients' long-term health and social well-being.
在资源有限的环境中，盆底功能障碍影响着多达50%的女性，但治疗严重不足。从历史上看，关注重点一直是泌尿生殖瘘，但盆腔器官脱垂（POP）正成为一个日益严重的问题，尤其是对于从事体力劳动的女性。由于社会耻辱感和心理健康影响，再加上医疗保健获取障碍，这些地区的女性往往默默忍受着她们的病情。由于工具和设备有限，在资源有限的环境中提供泌尿妇科服务需要适应性强的手术模式和技能。诊断治疗方法必须针对这些环境的独特挑战进行调整。
本文基于资源有限环境中的有限证据和专家经验，提供了一份管理膀胱阴道瘘、慢性四度撕裂和盆腔器官脱垂的实用指南。概述了关键诊断工具、手术技术和病例管理策略，解决了资源稀缺和患者随访等挑战。
本文强调了在诊断测试机会有限的情况下进行精确诊断、适应性手术干预和术后护理的重要性，提供了可持续的解决方案，尽管设备可用性有限，但能最大限度地提高患者治疗效果。文中展示了病例，以说明针对尿失禁、大便失禁和盆腔器官脱垂的实际诊断和手术方法。
本文强调需要一种适应性强的护理模式，该模式优先考虑具有成本效益、可重复的方法，同时考虑患者的长期健康和社会福祉。
